The Patient Protection and Affordable Care Act(ACA) has made many insurers rethink their path to a profitable and sustainable future. The ACA poses numerous hurdles to overcome including maintaining an MLR of 80-85% or more, writing profitable yet affordable products for the individual marketplace, and overcoming a surge of new competition. However, despite these risks, the ACA also provides a wealth of opportunities including tapping into a pool of 41 million uninsured Americans.
In order to gauge the current state of the U.S. health insurance industry and its future prospects with regards to the ACA, WNS DecisionPoint(TM) carried out a detailed study of 20 health insurance companies in the U.S., supplemented by expert interviews. This study aimed to gather insights on the financial performance and current maturity of health insurance companies across the entire payor value chain. Based on this study, several key strategies emerged for insurers to maintain and increase profitability in this new landscape:
- Educate and simplify insurance for the uninsured and nurture long-time customers to encourage loyalty
- Determine lifestyle and disease management program mix based on local customer profiling
- Track performance of physicians/doctors, compare medical outcomes and best practices to not only improve care management but encourage performance based risk sharing
- Streamline workflows and processes with automation and invest in analytics solutions to improve operating efficiency
To find out more about the new opportunities the Affordable Care Act opens up for insurers and how to leverage them, browse our slideshare deck or read the full report at: